It is one of the phrases we hear most often in clinic: "I'd rather skip the biopsy, I don't want to become impotent." That fear, while understandable, leads many men to postpone a test that can catch cancer early.
Where the myth comes from
The prostate is surrounded by nerve structures involved in erections, so it feels natural to assume that "puncturing" the gland could damage them. Confusion with prostate surgery — a different procedure that can affect erectile function in some cases — adds to the myth.
What the evidence says
A prostate biopsy (transrectal or transperineal) uses a fine, ultrasound-guided needle that does not cross the nerve bundles responsible for erections. Follow-up studies show erectile function three months after the procedure is comparable to baseline. When symptoms do appear, they are usually temporary.
Actual risks of the procedure
Like any medical procedure, a biopsy has possible effects: mild blood in urine or semen for a few days, local discomfort, and infection (uncommon, and preventable with antibiotics or the transperineal approach). Your urologist should walk you through all of this beforehand.
The bottom line
Delaying an indicated biopsy out of fear of impotence can cost far more than a few days of discomfort: prostate cancer caught early has very high cure rates. If you have doubts, discuss them openly with your urologist — that is what we are here for.